Pitch abnormalities are a common manifestation of various voice disorders, with complex pathophysiological mechanisms involving changes in vocal fold tension, mass, and neuromuscular dysfunction of the larynx. This study aims to investigate the underlying physiological mechanisms of pitch-related disorders and explore diagnostic and therapeutic approaches, providing insights for clinical management.
Humans ; Voice Disorders/therapy* ; Vocal Cords/physiopathology*

Vocal cord paralysis （ VCP ） refers to the movement disorder of the vocal cord caused by the damage of the motor nerve conduction pathway that dominates the laryngeal muscles, which can be accompanied by sensory nerve disorder of the larynx. Symptoms of bilateral vocal cord paralysis include crying hoarseness, sucking cough, and laryngeal stridor, which can lead to asphyxia in severe cases. Our team recently used CO2 laser to treat such children, but the prognosis varies significantly. Case 1: A 2-year-old male, who had undergone tracheotomy 2 years prior, was diagnosed with "bilateral vocal cord paralysis with grade Ⅱ laryngeal obstruction" after birth. He maintained a tracheostomy until recently. Electronic laryngoscopy showed that the bilateral vocal cords were fixed in the midline, with a glottic fissure of about 1 mm. After surgical treatment, the outcome was good, and there was no recurrence during follow-up. A 1-year-old female, who had undergone tracheotomy over a year ago, was diagnosed with ' ①bilateral vocal cord paralysis; ②laryngomalacia; ③neonatal pneumonia.' She maintained a tracheostomy since then. Electronic laryngoscopy revealed that the bilateral vocal cords were retracted and fixed, with a glottic fissure of about 0.5 mm and limited vocal cord abduction. The postoperative outcome for this child was not good, and the tracheostomy tube was not removed.
Humans ; Vocal Cord Paralysis/surgery* ; Male ; Child, Preschool ; Female ; Laser Therapy ; Infant

ObjectiveTo analyze the clinical and epidemiological characteristics of confirmed cases of human monkeypox infection in Changning District， Shanghai， and to explore their clinical and epidemiological characteristics. MethodsClinical data from 10 reported cases of monkeypox in individuals residing in Changning District or identified by local medical institutions between July 20 and September 30， 2023， were collected. Epidemiological case investigations were conducted， and throat swabs， anal swabs， and rash swabs were collected by the treating medical institutions. Real-time fluorescence quantitative PCR was used for monkeypox virus nucleic acid testing， and descriptive epidemiological analysis was applied to analyze the epidemiological characteristics of the cases. ResultsAll 10 confirmed cases of human monkeypox infection were all young males with an average age of 35.4 years， all of whom belonged to the men who have sex with men （MSM） population， with no occupational clustering. The primary clinical symptoms included fever， rash， enlarged inguinal lymph nodes， and muscle soreness. Nine cases presented with a rash， and seven cases experienced fever symptoms. Among the 10 cases， one experienced fever， rash， enlarged lymph nodes， and muscle soreness； two had fever， rash， and enlarged lymph nodes； two had fever， rash， and systemic soreness； two had only a rash； one had fever or rash； and one was asymptomatic. Among the nine cases with a rash， the rash was mainly localized to the genital or anal area， with fewer cases presenting rashes on the limbs or trunk simultaneously. All cases reported a history of non-exclusive MSM behavior within 21 days before the onset of the disease. The interval between the last suspected high-risk exposure and the onset of symptoms was 4 to 10 days， with an average interval of 6.9 days. The time from the onset of fever to the appearance of a rash was 0 to 5 days， with an average of 1.87 days. ConclusionThe main clinical manifestations of human infection with monkeypox are fever， rash， and enlarged inguinal lymph nodes. The MSM population is a high-risk group for monkeypox infection， and its source of infection may be associated with MSM exposure. Early-stage symptoms are mild， leading to potential underdiagnosis. Additionally， patients may conceal information during the investigation process， which increases the difficulty of epidemic prevention and control.

Objective:Patients with Laryngopharyngeal Reflux（LPR） have chronic inflammation of the laryngeal mucosa leading to a high response state in the larynx, which may make the vocal fold movement too fast. This paper discusses the characteristics of vocal fold movement and voice onset by analyzing laryngeal high-speed videoendoscopy in patients with LPR. Methods:Forty patients with LPR were enrolled as LPR group. The diagnostic criteria of LPR included positive reflux symptom index（RSI） and reflux syndrome score（RFS） to identify suspected LPR, objective oropharyngeal DX pH monitoring was carried out, and positive Ryan index indicated reflux. According to age and sex matching, 40 healthy volunteers were selected as the normal group. Laryngeal high-speed videoendoscopy, and the vocal fold motion and vibration parameters, including vocal fold adduction time, vocal fold abduction time, vocal fold vibration onset mode（vocal onset time and mode） and the opening quotient of vocal fold vibration cycle. Statistical analysis was performed using SPSS 25.0. Results:The time of vocal fold adduction in LPR group（mean 225.81ms） was less than that in normal group（mean 277.01 ms）, and the difference was statistically significant（P<0.05）. There was no significant difference in adduction time between LPR group and normal group（P>0.05）. The vocal onset time in LPR group was significantly longer than that in normal group（P<0.05）. High speed video endoscope showed that there were 17 patients with hard onset in LPR group and 8 patients with hard onset in normal group, the difference was statistically significant（P<0.05）. There was no significant difference in the open quotient of vocal fold vibration between LPR group and normal group（P>0.05）. The vocal fold abduction time in LPR group（mean 372.92 ms） was less than that in normal group（mean 426.98ms）, but the difference was not statistically significant（P>0.05）. The time difference of bilateral abduction of vocal fold in LPR group was significantly higher than that in normal group（P<0.05）. Conclusion:The larynx of LPR patients is in a high response state, the vocal fold moves faster, and it is more likely to have a hard vocal onset. These may result in voice dysfunction.
Humans ; Vocal Cords/physiopathology* ; Laryngopharyngeal Reflux/diagnosis* ; Laryngoscopy/methods* ; Male ; Video Recording ; Female ; Middle Aged ; Adult ; Voice/physiology* ; Case-Control Studies ; Vibration

Objective:To analyze the characteristics of vocal fold vibration of normal people and patients with spasmodic dysphonia (SD) using laryngeal high speed videoendoscopy combined with glottal area wave analysis.Methods:This prospective study examined twenty healthy subjects (10 males and 10 females), 12 patients with adductor spasmodic dysphonia(AdSD) (2 males,10 females)as AdSD group and 2 patients with abductor spasmodic dysphonia(AbSD) (2 males) as AbSD group. Twelve of healthy subjects (2 males,10 females) were selected as control group according to AdSD group gender match. All the subjects were recruited from the Department of Voice, Zhongshan Hospital, Xiamen University from October 2019 to December 2020. All subjects underwent laryngeal high speed videoendoscopy and 10 vibration periods were selected from each recording and were used to quantitatively analyze the change of glottal area and vocal fold vibration parameters (Speed Quotient (SQ), Open Quotient (OQ) and Close Quotient (CQ)).Results:1. There were statistically significant differences in SQ, CQ and OQ between males and females in the healthy subjects ( t=12.28, 5.59, 5.59, P<0.05). The change of the glottal area during each vibration period in healthy subjects was relatively stable(0.19-0.42). 2. The change of the glottal area during each vibration period in AdSD subjects had larger fluctuations, with the glottal area change index fluctuating in the range of 0.31 to 0.62. The SQ value of the AdSD group was significantly lower than that of control group ( t=4.246, P<0.05). There were no significant differences in OQ and CQ between AdSD group and normal group ( t=1.064, 1.332, P>0.05); The SQ value of the AbSD group tended to increase compared to normal group. Conclusions:Laryngeal high speed videoendoscopy combined with glottal area wave analysis has a certain reference value in the studying the vibration characteristics of SD patients. SQ has good specificity.

Objective:To explore the dynamic changes of three-dimensional morphology of laryngeal soft tissue and its clinical value in the unilateral vocal fold paralysis (UVFP) patients through dynamic CT scanning during the process from inspiration to phonation.Methods:From October 2017 to July 2019, a retrospective study was performed in 18 patients with UVFP (10 males and 8 females with the range of age from 29 to 75 years old) and 10 normal subjects (5 males and 5 females with the range of age from 25 to 58 years old) in Department of Voice-Otolaryngology Head and Neck Surgery, Section Two, Zhongshan Hospital Xiamen University. The laryngeal dynamic computed tomography (CT) of cine mode was performed. Ten dynamic sequence images of vocal folds movements were obtained during the process from inspiration to phonation. Based on the dynamic changes of glottic area and the displacement of cricoid cartilage. The above dynamic sequence images were divided into inspiratory phase and phonation phase as well as open phase and closed phase. The soft tissue parameters were measured respectively, including vocal folds length, width, thickness and subglottal convergence angle. Independent-sample t test was used to analyze between UVFP group and control group. Results:During the process from inspiration to phonation, the morphology of vocal folds in control group was relatively stable at inspiratory phase and closed phase in phonation. When open phase and closed phase of phonation were switching, the morphology of vocal folds changed obviously. The length of vocal folds became longer (1.19±0.10) mm, the width became wider (2.19±0.17) mm, the thickness became thinner (2.66±0.56) mm, and the subglottal convergence angle decreased (31.45±4.78)°. Compared with the controll group, in the open phase, the thickness and width of the vocal fold on affected side in the UVFP group were thinner ( t=10.25, P<0.001) and wider ( t=5.25, P<0.001).While in the closed phase, the subglottal convergence angle was larger ( t=4.41, P=0.001).The width of the healthy side vocal fold in the UVFP was wider ( t=2.54, P=0.026) than that in the control group. The differences in other parameters were not statistically significant. Conclusions:Dynamic laryngeal CT scanning provides a simple and non-invasive method for the objective and quantitative measurement of the dynamic changes of laryngeal morphology from inspiration to phonation. Compared with the control group, the characteristic dynamic changes among UVFP were observed during this particular process, which included changes of subglottal convergence angle and thickness of vocal muscle due to denervation. In addition, in UVFP group, the width of the vocal fold healthy side in the closed phase may be used to assess its compensatory function.

Objective: To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis. Methods: Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image. Result: Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively. Conclusion Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.

Objective To study the effect of sub-glottal convergence angle on the degree of glottal closure, and to analyze the potential mechanism of dysphonia by the incomplete glottal closure.Methods Three vocal fold positions (adduction, intermediate and abduction) were evaluated by the degree of glottal closure, and divided into three groups.The neck CT images of the subjects were gathered.The vocal folds were adduction group when the normal subjects made a sustaining phonation /i:/ during CT scanning;the vocal folds were abduction group when the normal subjects made a deep breathing during CT scanning, and the unilateral vocal folds were incomplete closing group when the unilateral vocal fold paralysis subjects made a deep breathing during CT scanning.3D models of the vocal folds and the airway were reconstructed using Mimics software, through which the sub-glottal convergence angle was measured.Using one-way factor analysis of variance, we compared the angle among three groups.Results The angle changed with degree of glottal closure, with statistically significant differences among the three groups(P<0.01).The means of the angle in three groups were 33.49°±3.75°, 55.03°±2.61° and 75.02°±7.32°.Conclusion The 3D model generation from CT data is an effective method of measuring the sub-glottal convergence angle, while the angle changes with the degree of glottis closure.The angle may affect sub-glottal pressure distribution in the sub-glottal shear or normal direction and influence vocal fold vibration, which would make vibration and vocal fold mucosal wave generation more difficult, and might cause dysphonia.

OBJECTIVE: To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases. METHOD: The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F₀) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test. RESULT: (1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR. CONCLUSION The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.
Acoustics ; Adult ; Arytenoid Cartilage ; physiopathology ; Case-Control Studies ; Electromyography ; Female ; Humans ; Male ; Software ; Vocal Cord Paralysis ; diagnosis ; Vocal Cords ; physiopathology ; Voice Quality

Objective To compare the acoustic signal,mucosal wave and aerodynamic parameter (phonation threshold pressure,PTP) under different sub-glottal pressure (SGP) on the excised canine models with different extent of glottal incompetence.Methods Perturbation measures and nonlinear dynamic measures were applied to analyze the acoustic signal (jitter,shimmer),mucosal wave [frequency (F),amplitude (A),phase (P)] and PTP from our study including 11 excised canine larynges with different extent of glottal incompetence (0 mm,1 mm,2 mm,3 mm,n =11,respectively) under 1-4 kPa sub-glottal pressure.Results There were significant differences between different groups in jitter,shimmer,amplitude,frequency and PTP under various SGPs and extent of glottal incompetence (all P ＜ 0.05),inversely,there was no significant difference in P between groups (P ＞ 0.05).Jitter and shimmer changed obviously when the SGP increased to 3 kPa in the control group and GI 1 mm group.Jitter and shimmer changed obviously when the SGP increased to 2 kPa in the GI 2 mm and 3 mm groups.The F and A of mucosal wave increased with increasing SGP,decreased with increasing GI,and the P changed irregularly.There was statistically significant difference of PTP between different GI groups.Conclusions The SGP and the extent of GI had obvious affection on the the acoustic signal,mucosal wave and aerodynamic parameters.